Lower Limb Amputations, Indications and Outcome

Objective: This study was carried out to determine indications of lower limb amputations and its out-come and complications.Study design and Duration: It is a prospective type of study.Setting: This study was conductedPatients and Methods: Total 75 cases were studied. These cases were reported in emergency department and out- patient doors. Some of them underwent amputations on emergency basis due to septicemia and deep infections causing threat to life. Mostly cases underwent amputation on elective basis. These cases were admitted in the ward. All necessary investigations were carried out and they were evaluated for anesthesia fitness. On emergency basis operation was done in emergency department and elective amputations were done in main operation theater. A written consent was taken from all patients and also from the medical superintendant of the hospital for conducting this study. A proforma was designed for documenting presenting complaints, cause of amputation, total hospital stay, Outcome and complications after operation. After discharge from the ward these cases were called for follow-up and stump was examined for necrosis, infection or hematoma etc. All data was analyzed using Microsoft office and SPSS version 2007. Results were calculated in the form of frequencies and expressed via tables and graphs. Results: Out of 75 cases 28(37.3%) cases underwent amputation of lower limbs on emergency basis and 47() cases were operated on elective basis. Ages of these cases was ranging from 30-75 years with mean age of 45.7 years. Mostly cases were above 40 years of age. There were 11(14.7%) cases with age range of 30-40 years, 17 with 41-50 years, 28 between 51-60 years, 7 cases between 61-70 years and 12 cases with age above 70 years. There were both male and female populations in this study group. There were 60(80%) males and 15(20%) female patients. It was seen that in most of the cases right limb was involved more than left limb. In 72% cases right lower limb and in 28% cases left lower limb amputation was done. There were different causes of amputation such as in 32 cases diabetes was cause, in 18 cases trauma, in 20 cases acute vascular insufficiency and in 5 cases infection was cause of lower limb amputation. Leading cause was diabetic foot. Most common complication seen after operation was wound infection seen in 23 cases, wound hematoma in 6 cases and stump necrosis in 3 cases was found. Out of 75 pos operative cases 50 were discharged, 15 were referred, 7 cases left against medical advice and 3 cases died due to septicemia and multi organ failure.    Conclusion: Lower limb amputation is most commonly performed amputation. Main cause of amputation is diabetic foot leading to osteomylitis. Common post operative complication is wound infection. Lower limb amputation is a life saving procedure in most cases. Incidence of this amputation can been decreased by controlling causative factors and limiting the disease in early stages

Clinical outcome of post placental IUD CuT380 insertion in terms of expulsion

Background: Insertion of an intrauterine contraceptive device (IUD) immediately after delivery has been recommended by the World Health Organization (WHO), as one of the safe and effective methods of temporary contraception. In the immediate post delivery period the women are highly motivated and need an effective method for contraception so that the child can be brought up with a relaxed mind without the worry of unintended pregnancy. This approach is more applicable to our country where delivery may be the only time when a healthy woman comes in contact with health care personnel. However, immediate post-partum IUD insertion may have disadvantages as well. The risk of spontaneous expulsion may be unacceptably high.Methods: After taking approval from hospital ethical committee, all women planning vaginal delivery desiring IUD, admitted through OPD and emergency were evaluated in detailed on design Performa Performa include patient’s identity, age, parity, gestational age, no of alive children, outcome and timings of insertion. Informed consent was obtained. With aseptic precautions IUD was inserted with kellys forceps in the uterine cavity up to the fundus, then cervix was examined for thread (that should not be visible at cervix if proper insertion done). The procedure was performed by myself. Patients were followed at 6week by examining the threat of IUD. All the information was recorded by myself. Follow up was done by taking patients contact number.Results: In our study, out of 300 cases, 63.67% (n=191) were between 18-30 years of age while 36.33% (n=109) were between 31-40 years of age, mean+sd was calculated as 29.49+4.62 years, mean gestational age was calculated as 38.53+0.94 weeks, mean parity was calculated as 3.49+1.06 paras. Frequency of expulsion in post placental intra uterine device cuT 380 insertions reveals in 8.67% (n=26).Conclusions: We concluded that the frequency of expulsion in post placental intra uterine device cuT 380 insertions is not significantly higher and appears to be safe and effective method of contraception.

Determine the frequency of peripartum hystrectomy in placenta previa

Background: Peripartum hysterectomy is one of the life saving procedure performed after vaginal delivery or caesarean birth or in the immediate postpartum period in cases of intractable haemorrhage due to uterine atony, rupture uterus and placental disorders and it is usually reserved for the situations where conservative measures fail to control the haemorrhage. The objective of the study was to determine the frequency of peripartum hysterectomy in placenta praevia.Methods: The study was cross-sectional. It was conducted at the Department of Obstetrics and Gynaecology, Punjab Medical College and affiliated Hospital, Faisalabad. Study was carried out over a period of six months from October 2010 to March 2011. Total 130 cases of placenta praevia undergone caesarean section were included in this study. In cases of primary postpartum haemorrhage conservative management was done first in the form of intramuscular syntometrine (Oxytocin 5 IU/ergometrine 0.5 mg). Intravenous infusion syntocinon (40 IU in 500ml 0.9% saline over 4-6 hours).Results: Mean age of the patients was found to be 30.9±6.7 years. Distribution of cases by gestational age shows, 52 (40.0%) patients had gestation of 28-36 weeks and 78 (60.0%) patients had gestation of 37-41. Mean gestational age was observed 37.5±3.4 weeks. Parity distribution was as follows: 76 (58.5%) patients had parity 0-3, 34 (26.1%) patients had parity 4-6 and 20 (15.4%) patients had parity > 6 with mean parity of 3.2±1.9. Conservative management was done in 129 patients (99.3%). Peripartum hysterectomy was found to be in 1 patient (0.7%).Conclusions: Placental pathology is the leading cause of postpartum hemorrhage and the main indications of peripartum hysterectomy. Timely operation minimizes the morbidity and mortality

An Ensemble Learning Method for Emotion Charting Using Multimodal Physiological Signals

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DEVELOPMENT, FABRICATION, AND PERFORMANCE EVALUATION OF INDIRECT MULTI-PORTIONED TYPE SOLAR DRYER FOR AGRICULTURAL PRODUCE

OBJECTIVE: The primary objective of this study was to minimize post-harvest damages and improve the handling of agricultural commodities. The secondary objective was to assess the performance of the dryer by varying inlet velocity of air on temperature, final moisture of the product, drying period, and drying rate METHODS: The present research was carried out for the development, fabrication, and testing of a multi-portioned type solar dryer. The multi-portioned dryer consisted of a collector unit, air storage chamber, drying cabins, and a chimney. A fan assembly was also attached at the inlet of the collector and at the outlet of the drying compartment to control the air velocity and to remove the moist air. RESULTS: The data obtained from the experiments revealed that the maximum temperature elevation of 36.5oC was attained during a no-load test. The results obtained after carrying out load tests revealed that the maximum drying rate of 47 g/hr was achieved at the air inlet velocity of 3.2 m/s. The initial moisture content of 80.50% was brought down to 3.31% in five sunshine hours of 150 gram sliced potatoes. Each portion received air at varying speeds, and it was observed that the portion receiving air at the lowest speed had the maximum temperature. CONCLUSION: The lowest temperature elevation was recorded for the portion receiving air at the highest speed. The dryer was also found to be suitable for the on-field practical application for the drying of perishable commodities

The Blockade Imposed Against Qatar: An Analytical Study of WTO Principles

تسلط هذه الدراسة التحليلية الضوء على النتائج الناجمة عن الحصار المفروض على دولة قطر وانتهاك دول الحصار — المملكة العربية السعودية. دول الإمارات العربية المتحدة، البحرين ومصر- للاتفاقيات التجارية والاقتصادية تحت منطمة التجارة العالمية (WTO). كما أنها تركز على الأسس القانونية للشكاوى التي رفعتها دولة قطر ضد المملكة العربية السعودية. دول الإمارات العربية المتحدة والبحرين. وإجراءات تسوية المنازعات والسلطه القانونية لمنظمة التجارة العالمية (WTO). والاستثناءات الخاصة بالأمن الوطني. فضلا عن المبادئ الأساسية لمعاهدات منطمه التجارة العالمية (WTO) بما فيها الاتفاقية العامة للتعرفة والتجارة الدولية (GATT). الاتفاقية العامة للتجارة في الخدمات (GATS) واتفاقية حقوق الملكية الفكرية المتعلقة بالتجارة (TRIPS).This analytical study sheds light on the consequences of the blockade imposed against Qatar and the violation of the blockading countries – the Kingdom of Saudi Arabia (KSA), the United Arab Emirates (UAE), Bahrain, and Egypt – of trade and economic agreements under the World Trade Organization (WTO). It also focuses on the legal basis of Qatar’s filed complaints against KSA, UAE, and Bahrain, WTO’s Dispute Settlement Procedures and jurisdiction, and the national security exceptions, as well as the main principles of the WTO treaties including General Agreement on Tariffs and Trade (GATT), General Agreement on Trade in Services (GATS), and Trade-Related Aspects of Intellectual Property Rights (TRIPS)

Knowledge and practice of menstrual hygiene management among women living in a low-income neighbourhood, Karachi, Pakistan

Background: The aim of the study was to determine the degree of awareness and practice of proper menstrual hygiene management among women living in low-income neighbourhood in Karachi, Pakistan.Methods: A cross-sectional study was conducted at the Bizerta Lines, Karachi between January and June 2019. All women of reproductive age were included in the study. Amenorrheic, menopausal, or women on birth control were excluded from the study. Degree of awareness and current practices pertaining to menstrual hygiene management were assessed through pro-forma. The study tool collected the participant’s knowledge, awareness, and misconceptions about menstruation. The factors affecting the quality of life during menstruation of women living in poor socio-economic conditions were also observed. Statistical Package for Social Sciences (SPSS v.23) was used to analyze the collected data.Results: Of the 338 participants, 82.5% had no knowledge of menstruation prior to their first menstrual period. Only a minority of the women knew that the source of menstrual blood was the uterus while 41.4% of the women incorrectly claimed that the menstrual blood and urine were expelled from the same orifice. More than half of the participants used disposable sanitary napkins (55.5%). 65% of the participants changed the absorbent at least 1 to 3 times a day.Conclusions: Most of the participants used disposable sanitary napkins. However, the basic knowledge of female anatomy and physiology behind menstruation was poor among women

A STUDY OF INTERNET THREATS, AVOIDANCE AND BIOMETRIC SECURITY TECHNIQUES - COMPARISON OF BIOMETRIC TECHNIQUES

In today’s IT world, most of the communication is done through networking. So, security of information is very crucial. A lot of techniques have been developed for security which involves passwords, encryption, digital signatures etc. But there are chances of vulnerabilities in these techniques and hackers can break the security algorithms of these techniques. So, in this era, researchers have moved towards biometric techniques of security. It involves identification of people based on their physical characteristics or psychological behaviors. A choice of biometric method to be used is made depending on the level of security required and the goals of the system. Biometric identification is very excellent and secure way of authenticating people. But it can also suffer from security threats, if proper design considerations are not taken into account. This work presents details of biometric techniques and a detailed comparison of most famous biometric techniques

Sonographic Evaluation of Cholelithiasis and Its Correlation with Normal/Fatty Liver

Cholelithiasis and Fatty Liver disease are usually observed to coexist. Patients who have gallstones also have Fatty Liver as both of the conditions have same associated risk factors I.e., diabetes mellitus, gender, age, obesity, metabolic syndrome, insulin resistance and high lipids level. Non-Alcoholic Fatty Liver Disease (NAFLD) is also an independent accountable risk factor for the formation of gallstones. We aimed to determine whether there is any correlation between cholelithiasis and fatty liver disease. The study was conducted in Lahore General Hospital, Lahore, Pakistan. The data was collected from March 24,2021 to May 24,2021. Informed consent was taken from all the participants. We did a cohort study comprising the data of 51 patients undergoing physical checkup. The data gathered included age, gender and whether they had normal or fatty liver. Cholelithiasis was diagnosed by confirming the presence of gallstones on abdominal ultrasonography after fasting for approximately 8hrs. it was an observational study for the assessment of correlation between cholelithiasis and fatty liver in the participants. A Total of 51 patients with cholelithiasis were included in our study. Most of the patients were 29 to 70 years of age. The average age of the patients was 42.3 ± 10.1 years. Out of 51 patients, there were 60.8% (P=31) females and 39.2%(P=20) males. Out of 51 cholelithiasis patients there were 31.4%(P=16) had Normal Liver and 68.6%(P=35) were positive with Fatty liver disease. Patients with stone size ranges from 1.90mm to 4.6mm hade Grade 1 Fatty liver as shown in table-5.4, Grade 2 Fatty liver was seen in patients with stone size ranges from 4.5mm to 5.8mm. Fatty liver Grade 3 was not observed in any included patient with cholelithiasis. Results of our study showed that both cholelithiasis and Fatty Liver disease are correlated with each other. Females are at higher risk to be affected by these with diseases. Early detection of Fatty liver in patients of cholelithiasis can help patients to prevent them further complications regarded to fatty liver and cholelithiasis and can play important role in health care of society. Keywords: Non-Alcoholic Fatty Liver Disease, Cholelithiasis, Fatty liver, Ultrasonography. DOI: 10.7176/JHMN/91-07 Publication date:July 31st 202

Impact of natural killer cells on outcomes after allogeneic hematopoietic stem cell transplantation: A systematic review and meta-analysis.

Background: Natural killer (NK) cells play a vital role in early immune reconstitution following allogeneic hematopoietic stem cell transplantation (HSCT). Methods: A literature search was performed on PubMed, Cochrane, and Clinical trials.gov through April 20, 2022. We included 21 studies reporting data on the impact of NK cells on outcomes after HSCT. Data was extracted following the PRISMA guidelines. Pooled analysis was done using the meta-package (Schwarzer et al.). Proportions with 95% confidence intervals (CI) were computed. Results: We included 1785 patients from 21 studies investigating the impact of NK cell reconstitution post-HSCT (8 studies/1455 patients), stem cell graft NK cell content (4 studies/185 patients), therapeutic NK cell infusions post-HSCT (5 studies/74 patients), and pre-emptive/prophylactic NK cell infusions post-HSCT (4 studies/77 patients). Higher NK cell reconstitution was associated with a better 2-year overall survival (OS) (high: 77%, 95%CI 0.73-0.82 vs low: 55%, 95%CI 0.37-0.72; n=899), however, pooled analysis for relapse rate (RR) or graft versus host disease (GVHD) could not be performed due to insufficient data. Higher graft NK cell content demonstrated a trend towards a better pooled OS (high: 65.2%, 95%CI 0.47-0.81 vs low: 46.5%, 95%CI 0.24-0.70; n=157), lower RR (high: 16.9%, 95%CI 0.10-0.25 vs low: 33%, 95%CI 0.04-0.72; n=157), and lower acute GVHD incidence (high: 27.6%, 95%CI 0.20-0.36 vs low: 49.7%, 95%CI 0.26-0.74; n=157). Therapeutic NK or cytokine-induced killer (CIK) cell infusions for hematologic relapse post-HSCT reported an overall response rate (ORR) and complete response (CR) of 48.9% and 11% with CIK cell infusions and 82.8% and 44.8% with NK cell infusions, respectively. RR, acute GVHD, and chronic GVHD were observed in 55.6% and 51.7%, 34.5% and 20%, and 20.7% and 11.1% of patients with CIK and NK cell infusions, respectively. Pre-emptive donor-derived NK cell infusions to prevent relapse post-HSCT had promising outcomes with 1-year OS of 69%, CR rate of 42%, ORR of 77%, RR of 28%, and acute and chronic GVHD rates of 24.9% and 3.7%, respectively. Conclusion: NK cells have a favorable impact on outcomes after HSCT. The optimal use of NK cell infusions post-HSCT may be in a pre-emptive fashion to prevent disease relapse